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CC BY-NC 4.0 · Arch Plast Surg 2014; 41(04): 366-373
DOI: 10.5999/aps.2014.41.4.366
Original Article

Aesthetic Design of Skin-Sparing Mastectomy Incisions for Immediate Autologous Tissue Breast Reconstruction in Asian Women

Bien-Keem Tan
Department of Plastic Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
,
Harvey Chim
Division of Plastic Surgery, Department of Surgery, University of Miami, Miami, FL, USA
,
Zhi Yang Ng
Department of Plastic Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
,
Kong Wee Ong
Department of Surgical Oncology, National Cancer Centre, Singapore
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Background The advent of skin-sparing mastectomy has allowed for the reconstruction of the breast and nipple with improved cosmesis. However, the nipple-areolar complex (NAC) in Asian patients is more pigmented and scars easily. Therefore, commonly described incisions tend to result in poor aesthetic outcomes in Asian patients with breast cancer.

Methods We describe an algorithmic approach to skin-sparing mastectomy incisions in Asian patients on the basis of the location of the biopsy scar and the tumor site and size. Four incision types are described: peri-areolar, a peri-areolar incision with a second distant skin paddle, "racquet handle," and peri-areolar with adjacent skin excision.

Results 281 immediate breast reconstructions were performed between May 2001 and February 2012 after skin-sparing mastectomy. The mastectomy incisions used included the peri-areolar design (n=124, 44%), peri-areolar design with a second distant skin paddle (n=39, 14%), "racquet handle" (n=21, 7.5%), and peri-areolar design with adjacent skin excision (n=42, 14%). The traditional elliptical incision and other variants where the NAC outline was not preserved were performed in the remaining 55 patients. The average follow-up was 44.7 months during which there was 1 case of total flap loss and 7 cases of partial flap necrosis; all remaining flaps survived. 24% of the patients (68/281) underwent subsequent nipple reconstruction.

Conclusions Our algorithm avoids breast incisions that are randomly placed or excessively long and prevents the unnecessary sacrifice of normal breast skin. This allows skin-sparing mastectomy and immediate breast reconstruction to be performed with a consistently achievable aesthetic result in Asian women without neglecting oncological safety.

Keywords

Mastectomy - Mammaplasty - Breast - Asia - Esthetics


Publikationsverlauf

Eingereicht: 06. Mai 2014

Angenommen: 01. Juli 2014

Artikel online veröffentlicht:
05. Mai 2022

© 2014. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

Thieme Medical Publishers, Inc.
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  • References

  • 1 Toth BA, Lappert P. Modified skin incisions for mastectomy: the need for plastic surgical input in preoperative planning. Plast Reconstr Surg 1991; 87: 1048-1053
    CrossrefPubMedGoogle Scholar
  • 2 Elliott LF, Eskenazi L, Beegle Jr PH. et al. Immediate TRAM flap breast reconstruction: 128 consecutive cases. Plast Reconstr Surg 1993; 92: 217-227
    CrossrefPubMedGoogle Scholar
  • 3 Grotting JC, Urist MM, Maddox WA. et al. Conventional TRAM flap versus free microsurgical TRAM flap for immediate breast reconstruction. Plast Reconstr Surg 1989; 83: 828-841
    CrossrefPubMedGoogle Scholar
  • 4 Carlson GW. Skin sparing mastectomy: anatomic and technical considerations. Am Surg 1996; 62: 151-155
    Google Scholar
  • 5 Bensimon RH, Bergmeyer JM. Improved aesthetics in breast reconstruction: modified mastectomy incision and immediate autologous tissue reconstruction. Ann Plast Surg 1995; 34: 229-233
    CrossrefPubMedGoogle Scholar
  • 6 Hidalgo DA. Aesthetic refinement in breast reconstruction: complete skin-sparing mastectomy with autogenous tissue transfer. Plast Reconstr Surg 1998; 102: 63-70
    CrossrefPubMedGoogle Scholar
  • 7 Chagpar AB. Skin-sparing and nipple-sparing mastectomy: preoperative, intraoperative, and postoperative considerations. Am Surg 2004; 70: 425-432
    Google Scholar
  • 8 Hammond DC, Capraro PA, Ozolins EB. et al. Use of a skin-sparing reduction pattern to create a combination skin-muscle flap pocket in immediate breast reconstruction. Plast Reconstr Surg 2002; 110: 206-211
    CrossrefPubMedGoogle Scholar
  • 9 Stradling BL, Ahn M, Angelats J. et al. Skin-sparing mastectomy with sentinel lymph node dissection: less is more. Arch Surg 2001; 136: 1069-1075
    Google Scholar
  • 10 Carlson GW. Technical advances in skin sparing mastectomy. Int J Surg Oncol 2011; 2011: 396901
    PubMedGoogle Scholar
  • 11 Slavin SA, Schnitt SJ, Duda RB. et al. Skin-sparing mastectomy and immediate reconstruction: oncologic risks and aesthetic results in patients with early-stage breast cancer. Plast Reconstr Surg 1998; 102: 49-62
    CrossrefPubMedGoogle Scholar
  • 12 Losken A, Mackay GJ, Bostwick 3rd J. Nipple reconstruction using the C-V flap technique: a long-term evaluation. Plast Reconstr Surg 2001; 108: 361-369
    CrossrefPubMedGoogle Scholar
  • 13 Zenn MR, Garofalo JA. Unilateral nipple reconstruction with nipple sharing: time for a second look. Plast Reconstr Surg 2009; 123: 1648-1653
    CrossrefPubMedGoogle Scholar
  • 14 Kroll SS, Ames F, Singletary SE. et al. The oncologic risks of skin preservation at mastectomy when combined with immediate reconstruction of the breast. Surg Gynecol Obstet 1991; 172: 17-20
    PubMedGoogle Scholar
  • 15 Missana MC, Laurent I, Germain M. et al. Long-term oncological results after 400 skin-sparing mastectomies. J Visc Surg 2013; 150: 313-320
    CrossrefPubMedGoogle Scholar
  • 16 Romics Jr L, Chew BK, Weiler-Mithoff E. et al. Ten-year follow-up of skin-sparing mastectomy followed by immediate breast reconstruction. Br J Surg 2012; 99: 799-806
    CrossrefPubMedGoogle Scholar
  • 17 Seifert O, Mrowietz U. Keloid scarring: bench and bedside. Arch Dermatol Res 2009; 301: 259-272
    CrossrefPubMedGoogle Scholar
  • 18 Teo SY, Chuwa E, Latha S. et al. Young breast cancer in a specialised breast unit in singapore: clinical, radiological and pathological factors. Ann Acad Med Singapore 2014; 43: 79-85
    PubMedGoogle Scholar
  • 19 Komorowska-Timek E, Gurtner GC. Intraoperative perfusion mapping with laser-assisted indocyanine green imaging can predict and prevent complications in immediate breast reconstruction. Plast Reconstr Surg 2010; 125: 1065-1073
    CrossrefPubMedGoogle Scholar
  • 20 Moyer HR, Losken A. Predicting mastectomy skin flap necrosis with indocyanine green angiography: the gray area defined. Plast Reconstr Surg 2012; 129: 1043-1048
    CrossrefPubMedGoogle Scholar
  • 21 Serletti JM. Breast reconstruction with the TRAM flap: pedicled and free. J Surg Oncol 2006; 94: 532-537
    CrossrefPubMedGoogle Scholar
  • 22 Benelli LC. Periareolar Benelli mastopexy and reduction: the "round block". In: Spear SL. Surgery of the breast: principles and art. Philadelphia: Lippincott-Raven; 1998: 685-696
    Google Scholar
  • 23 Kinoshita S, Kyoda S, Hirano A. et al. Clinical comparison of four types of skin incisions for skin-sparing mastectomy and immediate breast reconstruction. Surg Today. 17.09.2013. [Epub] http://dx.doi.orgl/10.1007/s00595-013-0722-2
    Google Scholar